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General NPI Number Information
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NPI Number | 1669542379
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Entity Type | Organization
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Legal Business Name | COMMUNITY RENEWAL TEAM
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 675 TOWER AVE
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City | HARTFORD
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State | CT
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Zip | 06112-1260
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Country | US
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Telephone | 860-714-3729
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Fax |
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Provider Business Mailing Address
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Address Line | 15 BALABAN RD
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City | COLCHESTER
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State | CT
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Zip | 06415-1701
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Country | US
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Telephone | 860-537-6100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LENA RODRIGUEZ
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Credential |
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Telephone | 860-560-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000827
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000172
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License Number State | CT
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